It all started with a man named Robin McKenzie, who was initially a practitioner in New Zealand. In 1956 Robin was beginning treatment for an individual with low back pain that started in the gluteal region and went down his leg to his knee. This particular patient was able to bend forwards, but could not bend backward. In the 1950s, bending the spine backward was considered to be a dangerous position for the spine.
However, this patient reported that after lying on the table for 5 minutes while Robin addressed pre-treatment chores, the pain down his leg dissipated and he was able to bend both forward and backward with less pain. What little pain he did have was centralized to the center of the spine. Over the next 15 years, Robin developed a system of diagnosis and methodology that allows the physical therapy profession of today to effectively assess the spine.
Thankfully, Robin’s technique and theory from the 1950s evolved and progressed through hours and years of trial and error. This lead to the birth of The McKenzie Institute, which has become a governing body for the theory of Mechanical Diagnosis and Therapy. The Institute has been able to generate a plethora of high-end research that supports the protocols of the method.
One may ask, “What is the big deal about all this and how does it relate to me?” Well, I’m glad you asked!
The benefit of this foundation is that it provides structure to the method. In other words, whenever a McKenzie physical therapist meets someone, the method trains us to immediately attempt to address whatever the deficit(s) are that the person is facing.
To explain in context – as soon as I meet a new patient, I try to get to the true causes of the condition from our very first conversation. I do this by piecing together bits of information to create the entire picture of the dysfunction for the individual. Without this full picture, it can be easy to wind up simply going through the diagnostic motions of therapy instead of actually targeting the problem at hand. This method unfortunately can keep people in PT for very long without any results.
The most difficult part of the aforementioned process is the ever-evolving and minute differences between each human body.
For example, let us say that both Jane and John Doe come into therapy for low back pain that refers to the outside of the right leg. Initially, both people benefit from the same interventions. However, at week 3 of faithful rehabilitation, John plateaus in progress but Jane continues to improve. Even though they had the EXACT SAME initial presentation, later down the road we are finding that we have to do different things with them to make progress.
This sort of thing happens all the time in physical therapy and proves to us that no person is the same. There is no cookie-cutter approach to physical therapy that applies to everyone. We have to be constantly assessing and evaluating if we want to be able to provide the most effective care possible. For me, the McKenzie method of diagnosis is the way that I navigate through this process of constant evaluation and assessment.
Another reason that I choose to utilize this logical method of deduction is that it is based around creating autonomy for the individual through repetitive motion. By teaching someone ways to address their symptoms on their own, I can empower them with the tools to combat their symptoms in the moment, before it becomes out of hand.
My primary role in this situation is to guide people through this process, which will inevitably change as the individual progresses towards their goal. Injuries can take quite a long time to heal even when we are working on them as hard as we can. Being able to say “My name is X and I have this issue, but it is happening to me much less frequently and when it happens it is much less severe. Most importantly, I am able to abolish this pain for a while on my own.”
At this point, I have spent five paragraphs validating the reasons why I use the McKenzie method, but it is very important to note that the method is not all-encompassing. Mechanical Diagnosis and Therapy is excellent for developing a reasoning process and addressing a plan, but in any case, there are other things that must be done. For example, someone with neck or back pain will almost always have an underlying weakness or loss of motor control. Simple, repeated motions will not properly address this, meaning that there are things that we need to do in addition to interventions designed for pain control. This almost certainly looks like strengthening, manual therapy, or soft tissue work.
Essentially, we physical therapists must follow the age-old hunger for knowledge. Treating one case the same as another is a method that will leave some people without relief. Mechanical Diagnosis and Therapy from the McKenzie Institute is simply the way that I prefer to ensure that I am asking the needed questions in care for those that I work with.
In this field, there will always be new challenges and different ways that patients experience their injuries, and I am grateful and excited to be able to continue venturing down each and every path with you, my patients in Asheville! If you have been struggling with a pain in the back and would like more information about how I go about my process, feel free to send me an email or call the office for an evaluation!